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Tuesday, 10 December 2013

I am not a Doctor: Part 2

Shortly before this blog’s summer campervan trip, Jean wrote about her experience of not being a doctor. She is and she isn’t a doctor. Jean is a doctor in that she graduated from the MBBS course at medical school with a string of stellar accolades, and she is also a doctor in that she has an epidemiological PhD in something I don’t quite understand. However, Jean is not a doctor in the practicing medical sense of doctor that you’d go to see with a worrying cough or a sore toe – and that’s the sort of doctor members of the public tend to think of when they hear the term ‘doctor’, which is where things get complicated. I’m not a doctor either, though not in any sense of the term – my pre-public health degrees are in Religious Studies and Creative Writing, my PhD is still two years from completion, and the only people who call me Dr Yoeli are the endless PPI insurance call centre operatives who think they’re speaking to my husband. Nevertheless, it’s often the case when I try to members of the public what I do within Fuse that people assume that I am a medically-qualified and practicing doctor, and sometimes the case that I’m asked for advice on the basis of this assumption, too. I always feel that I’m disappointing people by telling them I can’t help. But really, most of us in Fuse would tell you that they couldn’t help, either. I thought I’d write this blogpost to explain why not.

1. We study public health, not illness. We try to make populations healthier, not sick people better. There are many fine lines and commonalities and contested territories between public health and medicine. However, we won’t necessarily know much, if anything, about the illness you’re describing. Although we may be able to explain why and how you should stop smoking to lessen your chances of getting lung cancer, we probably won’t know enough about cancer itself to be able to comment on whether your father-in-law is receiving the appropriate chemotherapy regime for his stage and grade of tumour. So given that we know there are others more qualified to answer the question than ourselves, we’ll probably advise you to contact one of the relevant charities or advocacy groups with helplines dedicated to supporting and informing carers.

2. We do academic work, not clinical practice. We deal with people as research participants rather than as patients – and many of us deal with statistics or qualitative data rather than with people at all. As Hippocrates wrote, being a doctor requires not only knowing about illnesses but about patients. Although we may know that the blood glucose reading of Nmmol/l you got from borrowing your neighbour’s monitor is abnormally high and almost inevitably indicative of diabetes, we probably won’t have enough awareness of your personal medical history or sufficient experience of others presenting with similar blood glucose levels to know how likely you are to suddenly fall into a coma. So given that we probably know that untreated diabetes can be extremely serious and sometimes fatal, we will almost inevitably simply advise you to seek immediate medical help from a practicing clinical doctor.

3. Doctors are insured for giving medical advice; we’re not. Medical doctors in clinical practice are indemnified by specialist medico-legal practitioners which underwrite the risk of them giving incorrect advice or doing harmful things to patients. So if you sue a doctor for giving your father-in-law the wrong chemotherapy drug or for erroneously reassuring you that you don’t have diabetes, the doctor’s insurers will pay. If you were to sue us for offering dodgy advice, our university’s insurers would not pay. And because our university’s insurers would not pay, our universities would immediately fire us for the very grossest of gross misconduct, probably at rather massive cost to our career standing. So given that we know that we won’t necessarily be able to offer you good advice, and given that we could face catastrophic consequences for offering you bad advice, we tend not to offer any advice at all.

Most people in Fuse wont offer medical advice, because they don't want to get sued...

This three-point explanation aside, however, there’s a lot of theory about when, why and how ‘lay referral networks’ function to determine the circumstances people might or might not seek medical advice for a particular illness or symptoms. My anecdotal impression is that some people do seem to gain some validation or comfort from having academics tell them that they’re really not able to provide the medical advice requested. Has anyone ever studied the phenomenon or role that academics might play within this process? I would be interested to know.

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Fuse is a UKCRC Public Health Research Centre of Excellence. Fuse is a ‘virtual’ research centre, with staff and students based at five universities in the North East of England. We exist to conduct high quality research on improving public health and translating public health evidence into practice.